Interview with ASN Member, Dr. Steven B. Heymsfield

Interview with ASN Member, Dr. Steven B. Heymsfield

Steven B. Heymsfield, MD, has been an ASN member since 1979.
Transitioning from Merck & Co. Inc. to serve as the Executive
Director of Pennington Biomedical Research Center, Dr. Heymsfield
serves on the ASN Sustaining Member Committee.

Dr. Steven Heymsfield is one of the pharmaceutical industry's
leading weight-loss researchers. As the global director for
scientific affairs and obesity at Merck & Co., Dr. Heymsfield
has paved the way for a number of breakthroughs in clinical
nutrition. Some of his achievements in the field include the
development of the Lithogenic Index and the discovery that CT scans
could be used to analyze the relationship between obesity and liver
disease and between body fat and skeletal muscle mass. He is
the author of nearly 430 peer-reviewed scientific articles, six
books, and more than 114 book chapters or reviews on obesity,
anorexia, bulimia, malnutrition, pregnancy, body composition and
caloric expenditure.

Dr. Heymsfield, is a past president of ASN's predecessor
organization, the American Society of Clinical Nutrition, and was
recently appointed by Louisiana Gov. Bobby Jindal to head the LSU
System's Pennington Biomedical Research Center (PBRC). As one
of the world's foremost obesity researchers, Dr. Heymsfield
possesses a unique insight into the triumphs and challenges faced
by both industry and academic scientists working to develop new
weight loss treatments. He recently shared with us some of
those insights as well as details of how his long-time involvement
with ASN continues to help him encourage collaboration and stay
abreast of the latest research in obesity and weight
loss.

Interviewer: How did you first become interested in
nutrition?

Dr. Heymsfield: Well, I'm a
physician trained in internal medicine. As I reached the end
of my training, I gravitated very strongly towards research as
opposed to clinical practice. The first research environment
that I had a chance to work in was with Daniel Rudman who ran the
clinical research center at Emory University. Dr. Rudman was
a pioneer of metabolism and nutrition research. In the early
1970s, he was the first to introduce me to clinical nutrition and
to mentor me in the field. The 1970s was a period of
signficant growth for clinical nutrition because, among other
things, artificial feeding was just being introduced to the world.
It was many of the exciting related challenges that really swept me
into the field.

Interviewer: How did your
interest in nutrition research lead you to ASN?

Dr. Heymsfield: During the
time that I was training, ASN was the premier nutrition society,
which of course it still is. At that time, it was the American
Society for Clinical Nutrition (ASCN). As a young physician
scientist it was the most prestigious and most exciting society
related to the work that I was doing.

Interviewer: What about your
membership have you found most helpful to your career as a
nutrition researcher?

Dr. Heymsfield: ASN is the
home of a very large percentage of the scientists I collaborate
with and whose works I follow. For that reason, being a member of
the ASN has been invaluable in my career. It keeps me
knowledgeable of what other people are doing. Such an
important part of being a researcher is about knowing people first
hand—to be able to pick up the phone or to see them at meetings to
share ideas.

Interviewer: As a leader in
obesity drug development, what do you think are the biggest
challenges facing industry researchers today?

Dr. Heymsfield: In the
context of weight-loss drug development, I think the biggest
challenge we face has to do with metabolic pathways or receptors
used as targets for drug research. It's only been about a
decade since the field established the main targets for weight
control. And during that relatively short amount of time, it
has become clear that the systems that control weight are far more
complicated than we could have possibly imagined. Developing
weight-loss medications has revealed that if you hit one target
perhaps another one may compensate, preventing greater weight loss
than you might expect. We are still really learning how to
modulate them with drugs because of the complexity of weight-loss
mechanisms.

The flip side of this complexity is that there is not one system
that regulates body weight and nothing else. Weight is tied
to a number of other processes including heart rate, core
temperature, blood pressure, and menstrual cycles in women.
This interconnectedness means that when you hit weight-loss targets
with drugs, you do not just see a weight-loss effect. You may
also have some effects that you had not anticipated that are not
necessarily positive. That's been a huge challenge to the
field—to find drugs that are both clinically meaningful in terms of
efficacy but are also very safe.

Interviewer: Two of the
major issues we hear being discussed a lot right now are conflict
of interest and publishing concerns, such as the use of
ghostwriters. What are your thoughts on these issues and what
actions can industry researchers help alleviate these
concerns?

Dr. Heymsfield: If we
blanket the industry with one brush, you can see that if you go
back five years or ten years there was a process of ghostwriting,
which meant that professional writers or industry writers often
wrote papers using academic investigators' names. Since that
time, there has been a huge transformation. I can only speak for
Merck, but I feel that the process has completely turned around to
where every author on every paper is responsible for that paper and
for the content of that paper.

One of the problems that industry faces is that they want their
drugs to become known in the scientific community. One of the
best ways to do that is to publish these studies.
Unfortunately, clinical investigators in academia often do not have
the time or the interest to write those papers. So the
challenge for industry becomes getting high-quality investigators
to do that kind of writing for them or with them.

Another problem for the scientists within the industry, speaking at
least for Merck, is that they are extremely skilled, competent
scientists who should be authors or lead authors on these papers,
and they are not. The reason for that is if an industry
scientist puts their name as first author on a paper, when
interviewed by the press or the outside world, they are not given
adequate credibility because of conflict of interest. I think
that is a real problem that we have to solve; because when I look
around me at my colleagues, I see they are absolutely as competent
and as ethical as people in academia. I think that if there
was some transformation in that view, you would see more industry
authors coming out as leads in these papers, as they should be.

Another solution to this conflict is something being pursued at
Merck right now-- we bring in academic investigators before a study
is designed. They participate in the design, the execution,
the analysis, and the write-up of the study. In the past,
authors from academia were often asked or chosen after a study was
done, which doesn't qualify them to be lead authors on these
studies.

Interviewer: Speaking of
publishing, what sources do you usually turn to for medical
nutrition information? And what are your favorite strategies for
staying informed about what's going on in the field?

Dr. Heymsfield: One of the
most important ways for me to stay informed is to attend
Experimental Biology. That's where I hear what's coming in
the future as opposed what has happened in the past. By the
time you read a journal article, it has been a year or two since
that work was actually done. It is also important for me to
have a wide network of colleagues throughout the world. This
network fosters informal discussions that help me learn about
papers or topics that I might not have been aware of because you
can't stay on top of every issue all the time. My colleagues
at ASN are such an important part of that network.
Additionally, I subscribe to the key journals. I get the
American Journal of Clinical Nutrition and the Journal of
Nutrition. Those publications send emails with the table of
contents that I religiously review when they come in.